Cochrane · systematic review · CD004080
Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications
Herbert, G, Perry, R, Andersen, HK, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
17
current version
GRADE rated
17
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 4 · 23.5%Low 13 · 76.5%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyEarly enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement
Population: lower gastrointestinal surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Length of hospital stay (days) Early enteral nutrition within 24 hours of lower gastrointestinal surgery vs later commencement | no estimate extracted | 16 studies · 1346 participants | Low Downgraded: risk of bias, inconsistency |
Wound infection Early enteral nutrition within 24 hours of lower gastrointestinal surgery vs later commencement | RR 0.99 [0.64, 1.52] | 12 studies · 1181 participants | Very low |
Intraabdominal abscess Early enteral nutrition within 24 hours of lower gastrointestinal surgery vs later commencement | RR 1 [0.26, 3.8] | 6 studies · 554 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Anastomotic leakage/dehiscence Early enteral nutrition within 24 hours of lower gastrointestinal surgery vs later commencement | RR 0.78 [0.38, 1.61] | 13 studies · 1232 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Pneumonia (within hospital stay) Early enteral nutrition within 24 hours of lower gastrointestinal surgery vs later commencement | RR 0.88 [0.32, 2.42] | 10 studies · 954 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Mortality Early enteral nutrition within 24 hours of lower gastrointestinal surgery vs later commencement | RR 0.56 [0.21, 1.52] | 12 studies · 1179 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Vomiting Early enteral nutrition within 24 hours of lower gastrointestinal surgery vs later commencement | RR 1.23 [0.96, 1.58] | 7 studies · 613 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Nausea Early enteral nutrition within 24 hours of lower gastrointestinal surgery vs later commencement | RR 0.95 [0.71, 1.26] | 2 studies · 118 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Nausea and vomiting Early enteral nutrition within 24 hours of lower gastrointestinal surgery vs later commencement | RR 0.92 [0.6, 1.41] | 4 studies · 238 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Quality of Life Early enteral nutrition within 24 hours of lower gastrointestinal surgery vs later commencement | no estimate extracted | 1 study · 28 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Subgroup and Sensitivity analyses
Population: lower gastrointestinal surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Subgroup 1: Length of hospital stay (days) distal to ligament of Treitz | no estimate extracted | 13 studies · 1156 participants | Low Downgraded: risk of bias, inconsistency |
Subgroup 2: Length of hospital stay (days) distal and proximal to ligament of Treitz | no estimate extracted | 3 studies · 190 participants | Low |
Subgroup 3: Length of hospital stay (days) oral feeding only | no estimate extracted | 11 studies · 1075 participants | Low Downgraded: risk of bias, inconsistency |
Subgroup 4: Length of hospital stay (days) tube feeding with/without oral feeding | no estimate extracted | 5 studies · 271 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Sensitivity analysis 2: Removing studies with imputed results | no estimate extracted | 5 studies · 396 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Senstivity analysis 3: Worst case scenario imputation | no estimate extracted | 3 studies · 235 participants | Low Downgraded: risk of bias, inconsistency |
Senstivity analysis 4: Best case scenario imputation | no estimate extracted | 3 studies · 235 participants | Low Downgraded: risk of bias, inconsistency |
Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement
Population: lower gastrointestinal surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Length of hospital stay (days) Early enteral nutrition within 24 hours of lower gastrointestinal surgery vs later commencement | no estimate extracted | 16 studies · 1346 participants | Low Downgraded: risk of bias, inconsistency |
Wound infection Early enteral nutrition within 24 hours of lower gastrointestinal surgery vs later commencement | RR 0.99 [0.64, 1.52] | 12 studies · 1181 participants | Very low |
Intraabdominal abscess Early enteral nutrition within 24 hours of lower gastrointestinal surgery vs later commencement | RR 1 [0.26, 3.8] | 6 studies · 554 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Anastomotic leakage/dehiscence Early enteral nutrition within 24 hours of lower gastrointestinal surgery vs later commencement | RR 0.78 [0.38, 1.61] | 13 studies · 1232 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Pneumonia (within hospital stay) Early enteral nutrition within 24 hours of lower gastrointestinal surgery vs later commencement | RR 0.88 [0.32, 2.42] | 10 studies · 954 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Mortality Early enteral nutrition within 24 hours of lower gastrointestinal surgery vs later commencement | RR 0.56 [0.21, 1.52] | 12 studies · 1179 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Vomiting Early enteral nutrition within 24 hours of lower gastrointestinal surgery vs later commencement | RR 1.23 [0.96, 1.58] | 7 studies · 613 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Nausea Early enteral nutrition within 24 hours of lower gastrointestinal surgery vs later commencement | RR 0.95 [0.71, 1.26] | 2 studies · 118 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Nausea and vomiting Early enteral nutrition within 24 hours of lower gastrointestinal surgery vs later commencement | RR 0.92 [0.6, 1.41] | 4 studies · 238 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Quality of Life Early enteral nutrition within 24 hours of lower gastrointestinal surgery vs later commencement | no estimate extracted | 1 study · 28 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Subgroup and Sensitivity analyses
Population: lower gastrointestinal surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Subgroup 1: Length of hospital stay (days) distal to ligament of Treitz | no estimate extracted | 13 studies · 1156 participants | Low Downgraded: risk of bias, inconsistency |
Subgroup 2: Length of hospital stay (days) distal and proximal to ligament of Treitz | no estimate extracted | 3 studies · 190 participants | Low |
Subgroup 3: Length of hospital stay (days) oral feeding only | no estimate extracted | 11 studies · 1075 participants | Low Downgraded: risk of bias, inconsistency |
Subgroup 4: Length of hospital stay (days) tube feeding with/without oral feeding | no estimate extracted | 5 studies · 271 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Sensitivity analysis 2: Removing studies with imputed results | no estimate extracted | 5 studies · 396 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Senstivity analysis 3: Worst case scenario imputation | no estimate extracted | 3 studies · 235 participants | Low Downgraded: risk of bias, inconsistency |
Senstivity analysis 4: Best case scenario imputation | no estimate extracted | 3 studies · 235 participants | Low Downgraded: risk of bias, inconsistency |